Objective:

To evaluate the impact of extracapsular extension (ECE) on survival outcomes in patients with NSCLC following neoadjuvant chemoimmunotherapy (NCIT).

Approach:

• Patient Enrollment: 104 patients with NSCLC and pathologically confirmed lymph node metastasis who underwent surgery following NCIT were retrospectively enrolled.
• Statistical Analysis: Kaplan-Meier analysis and Cox proportional hazards regression evaluated the prognostic impact of ECE, with propensity score matching (PSM) to minimize selection bias.
• Predictive Accuracy Assessment: Time-dependent receiver operating characteristic (ROC) curves assessed predictive accuracy.

Key Findings:

• ECE-positive patients had significantly worse disease-free survival (DFS) than ECE-negative patients (HR = 2.37, 95% CI: 1.28–4.41, P = 0.006).
• Integrating ECE status with major pathologic response (MPR) improved predictive accuracy for 2-year DFS (AUC increased from 0.591 to 0.706).
• ECE did not significantly affect overall survival (OS), but lymphovascular invasion (LVI) was an independent predictor of OS (HR = 3.99, 95% CI: 1.59–10.02, P = 0.003).

Interpretation:

Limitations:

• The study is retrospective and may be subject to selection bias.
• The findings may not be generalizable to all NSCLC patients receiving NCIT.

Conclusion: